Hepatitis C: Transmission and prevention

Less common routes of transmission

  • During sex

Sexual transmission of the hepatitis C virus is possible, but much less likely than with hepatitis B.

Transmission may occur where blood-to-blood contact takes place, for example during anal sex or sex during menstruation. The risk is increased in these situations, and condom use is particularly recommended for prevention if there are any wounds in the genital area or other concomitant infections (e.g. herpes or HIV). Condoms are also recommended if there is a frequent change of sexual partners.

Sexual transmission of HCV between men and women appears rare, even in long-term relationships.

Sexual transmission of HCV between men has become more frequent in Europe in recent years, particularly between men who have HIV. Sexual practices that carry a risk of bleeding, such as fisting or rough anal intercourse, are strongly associated with hepatitis C infection. HCV may also be present in semen and rectal fluid and so may be passed on during anal sex even if bleeding does not occur.

  • Pregnancy and birth

The risk of HCV being transmitted to the foetus or newborn baby from a mother who has HCV, before or during delivery, is estimated to be around 1 to 6%. 1 The risk of transmission is not reduced by a caesarean section. Transmission of the virus is more frequent for expectant mothers who have both hepatitis C and HIV.

Experts generally do not advise against breastfeeding, as hepatitis C transmission through breast milk is considered highly unlikely. As a precautionary measure, however, they advise against it if nipples are inflamed or bleeding. Women who also have HIV are recommended not to breastfeed to avoid passing HIV on to their baby.

This information was originally adapted from Hepatitis C: Understanding a silent killer, published by the European Liver Patients Association. It was updated in 2016.

References

  1. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. J Hepatol 55:245-264, 2011